GPs not dissatisfied with performance related pay, study finds

Linking GPs' pay to their performance has no discernible effect on their job satisfaction, a University of Manchester study of almost 2,000 UK doctors over a four-year period has found.

Based on a belief that income is a key motivating factor, many countries have introduced performance related pay for GPs. In the UK this is known as the Quality and Outcomes Framework (QOF).

There have been concerns that this payment method can have adverse effects on GP morale and the UK scheme has been watered-down and may be withdrawn. But there has been no research to back up this claim. The new findings provide evidence that performance related pay does not reduce morale.

For the first time the University of Manchester study links levels of payment through the QOF to the GP Worklife Survey (also carried out by Manchester) at three time points - 2004 before the QOF was introduced, 2005 and 2008.

This group comprised 1,920 GPs who were assessed on overall satisfaction and 12 other measures including hours of work and levels of autonomy, recognition and responsibility.

Dr Thomas Allen, from the University's Manchester Centre for Health Economics, led the study. He said: "Policy makers have experimented with a number of ways to prevent GPs leaving their jobs, but dropping the link between pay and performance is not one that will work."

The time-frame covered a point (2004) when GP satisfaction was very low, and the introduction of performance-related pay was one measure that tried to address this. The findings from the year after introduction and four years later in 2008, showed satisfaction had improved across the board and was not related to the proportion of income at risk.

Further changes to QOF were made in 2013, outside of this study period, which reduced the exposure of GPs to performance related pay and returned more to an older model of payment per patient.

Maintaining high satisfaction is an important issue, not just for retaining GPs, but also for ensuring the best possible quality of care is provided.

The authors of the study believe that their findings have important implications for further changes to the source of GP income. "Policymakers should not believe that dropping performance-related pay for GPs will increase their satisfaction," Dr Allen said.

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The paper, 'Does the proportion of pay linked to performance affect the job satisfaction of general practitioners?' was published in the journal Social Science & Medicine. DOI: 10.1016/j.socscimed.2016.11.028

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